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"�� �-� � -�� <br /> � CITY OF ORONO <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> �O�O Mailing Address: Permit number: o��J�-��j�� <br /> PO Box 66 /�, <br /> Crystal Bay, MN 55323-0066 Date received: [�� '/,� <br /> StreetAddress:' Received by: <br /> y � 2750 Kelley Parkway Plan review fee: <br /> � G <br /> t Orono, MN 55356 <br /> �kFSH��� ��[/� O� <br /> Total Fee: <br /> Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us <br /> This application form must be completed in full and all required information must be submitted. <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: ,�I(� �� v �oQ� Q� <br /> Will this be a Parade of Homes, Remodeler Showcase Home or other Display Home? ❑ Yes �No <br /> If yes, a special event permit is required with Police Department and City Council approva/60 days prior to the event. Shuttle bus service will be <br /> requrred unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: �� �i1 S iC�(� MA�So I�f �R.Y <br /> State License# Expiration Date: <br /> Phone: (cell) �f a -y�j !� - /4'�'� (office) <br /> Mailing Address: Cit : �('���1 ZIP: <br /> Contact Person: �U K Applicant is: ontrac or / Homeowner �c��cie o�e> <br /> Email and/or Fax: � usl� f n� �.t,n•� <br /> PROPERTY OWNER INFORMATION: <br /> Name: <br /> Phone(day): <br /> Address: City: ZIP: <br /> Email and/or Fax <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: <br /> Phone (day): <br /> Address: City: ZI P: <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Description of project: <br /> 1.Type of Project 2. Proposed Use 3.Structure Type 4.Sewage Disposal & <br /> Water Supply <br /> ❑ New Construction ❑ Single Family with ❑ Residence <br /> �,Addition attached garage ❑ Garage/Accessory Bldg. ❑ Public Sewer <br /> ❑Accessory Building ❑ Single Family with ❑ Deck <br /> ❑ Relocation detached garage ❑ Office/Commercial ❑ Private Sewer <br /> ❑ Other: (specify) ❑ Multiple Family/Condo ❑Warehouse <br /> ❑ Public ❑ Storage ❑ Public Water <br /> **Any earth movement may also require ❑ Commercial �Other(specify) <br /> MCWD review 8�permits. ❑ Industrial co1�fi S�Dp ❑ Private Well <br /> Minnehaha Creek Watershed District(MCWD) � Other: (speCify) <br /> 18202 Minnetonka Blvd <br /> Deephaven,MN 55391 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.or <br /> Estimated Construction Valuation (exctuding land) $ ��,��,�� <br />